Clinical and biochemical aspects of chronic hepatitis in the conditions of intestinal dysbiosis

Abstract

Abstract. Prolonged intestinal dysbiosis (DB) increases the risk of developing metabolic liver diseases, such as nonalcoholic fatty liver disease (NAFLD), cholestasis, hepatocellular dysfunction and dyskinetic disorders of the biliary tract. According to various studies, hepatic steatosis is observed in almost 50% of patients with chronic hepatitis C (HCV). The presence of NAFLD in patients with CHC contributes to the onset and further progression of fibrosis from the initial stages to cirrhosis of the liver within a short time. The purpose of the research is to study the clinical and biochemical features of the course of chronic HCV in the conditions of intestinal dysbiosis. Materials and methods. There were 142 patients with chronic HCV under observation. The control group consisted of 20 healthy people. The diagnosis of chronic HCV was made according to the International Classification of Diseases of the 10th revision and confirmed by the detection of total IgG antibodies to HCV by enzyme-linked immunoassay, as well as the detection of RNA-HCV in the blood by polymerase chain reaction. All patients were determined the functional state of the liver by the level of activity of alanine and asparagine aminotransferases (ALT, AST), alkaline phosphatase (AP), conjugated bilirubin, gammaglutamyl transpeptidase (GGTP), trophological status was assessed and a microbiological study of feces was performed. To determine the degree of steatosis and fibrosis of the liver, a noninvasive diagnostic method – FibroMax was used. The obtained results allowed to divide all patients into two groups: 1 group (n = 84) of patients with chronic HCV + dysbiosis DB and 2 group (n = 58) of patients with chronic HCV without dysbiosis of the intestine. The analysis and processing of the patients’ examination results were carried out using the Statisticsfor Windows v.7.0 computer program (StatSoftInc, USA). Results and Discussion. It was found that the intestinal dysbiosis had 59.2% (84 out of 142) of patients with chronic HCV, and 52 of them had increased body weight, which was 61.9%. Clinical manifestations of intestinal microbiocenosis disorders in 58 patients were predominant constipation (69%) and minimization of typical diarrheal syndrome in 26 people (31%). A large number of patients with chronic HCV with the intestinal dysbiosis (82.1%) complained of decreased ability to work, headaches, depressed mood and sleep disorders, which confirmed the presence of asthenovegetative syndrome. Analysis of biochemical indicators demonstrated that cholestasis syndrome prevails in patients with chronic HCV in the conditions of intestinal dysbiosis, proving significantly higher levels of total bilirubin, AP and GGTP, compared with patients without dysbiosis (p < 0.05). Also, in patients with chronic HCV, in conditions of intestinal dysbiosis in 3.5 times (p < 0.001) were more often detected increased levels of liver enzyme activity (ALT, AST, GGTP), compared to patients without dysbiosis, which characterizes the cytolysis syndrome. In patients with chronic HCV with intestinal dysbiosis, in 1.6 times more often than in patients without dysbiosis, steatosis of the S1-2 degree was registered, and in 2.4 times more often S2-3. Inflammation in different degrees of hepatic steatosis in 2 times more common in patients with chronic HCV with dysbiosis than in patients without dysbiosis. It was found that in patients with chronic HCV combined with intestinal dysbiosis deep stages of liver fibrosis (F2-3 and F3-4) are registered in 3.6 times more often compared to patients only with chronic HCV (53.6% vs. 24.1% and 11, 9% vs. 3.4% p < 0.05). Conclusions. Intestinal dysbiosis is more often recorded in patients with chronic HC with increased body weight and is characterized by an atypical course, in the predominance of constipation (in 69% of patients). In patients with chronic HCV in the conditions of intestinal dysbiosis dyspeptic, asthenovegetative and cholestatic syndrome, as well as high activity of ALT and AST are more often observed, compared to patients without dysbiosis. According to Fibromax, patients with CHC with intestinal dysbiosis are in 2.4 times more likely to have hepatic steatosis of 2–3 degree (S2-3) and steatohepatitis (N2,) which characterizes the existing metabolic disorders.